By SHIRLEY S. WANG
Predicting whether a depressed patient will respond to a particular treatment is notoriously difficult, but findings from a small study released Wednesday provide another encouraging sign that more effective treatment may be possible one day using a brain scan.
The study of 63 patients with major depression identified a pattern of brain activity that appears distinct in those who responded to the antidepressant escitalopram, or Lexapro, compared with those who got better with a type of talk therapy.
A small but significant new study suggests that a brain scan could help doctors determine which patients are responding to antidepressants and which aren’t. Shirley Wang reports on the News Hub. Photo: Getty Images.
Antidepressants typically take weeks to exert an effect and only about half of patients get some benefit from any one drug, so figuring out sooner who responds to a medicine would aid treatment. Patients could be switched sooner to other medications instead of wasting time with a drug that doesn't work for them.
Psychotherapy also can take time and may be too cognitively taxing for some people with depression.
"We wanted to find a marker that would match them to a treatment that would work and avoid the treatment that wouldn't," said Helen Mayberg, an author of the study and professor of psychiatry, neurology and radiology at Emory University. "This is a first step. This is part of the march toward precision medicine in psychiatry."
Other studies have examined other possible biomarkers to predict antidepressant response, including another type of brain imaging using MRI, electrical patterns using EEG, blood tests and genetic markers. Several have yielded early findings that appear to distinguish between patients who respond to one type of drug versus another.
The new study, published in JAMA Psychiatry, is unique because it found a biomarker that distinguished between response to a drug compared with talk therapy, said Andrew Leuchter, a professor of psychiatry and biobehavioral science at the University of California, Los Angeles, who studies antidepressant-medication response but wasn't involved in the study.
In the study, the brains of all patients were scanned before treatment using positron emission technology, or PET, which involves injecting a radioactive chemical sugar into the blood. Regions of the brain that are more metabolically active take up more of the radioactive sugar and showed up as brighter in the scan.
Patients then were randomly assigned to cognitive-behavioral therapy or the antidepressant Lexapro. The scans of patients whose depression got completely better after 12 weeks were compared with those who didn't appear to improve at all.
In patients who saw improvement when they received medication, the researchers had found a pattern in the region of the brain called the insula that was distinct compared with those who responded to psychotherapy. That suggested the imaging technique could potentially be helpful in determining who should get which treatment.
Steven Zalcman, chief of the clinical neuroscience branch in a division of the National Institute of Mental Health, who wasn't involved with the study, called the findings "tantalizing" but said they needed to be studied further. The work was funded by grants from the National Institutes of Health, including the NIMH.
Write to Shirley S. Wang at shirley.wang@wsj.com
A version of this article appeared June 13, 2013, on page A7 in the U.S. edition of The Wall Street Journal, with the headline: Study Aims to Predict What Depression Remedy Works.
